A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?

A. "I will tell your family of your concern so that they can be here." This option involves the family in the client's care, which is important during end-of-life situations. However, it assumes that the client's primary concern is about the family's presence rather than exploring the underlying emotions or fears the client may be experiencing. While involving the family is beneficial, it may not directly address the client's emotional needs.
B. "I wonder if you are fearful of dying alone." This response demonstrates therapeutic communication by acknowledging the client's statement and exploring the underlying feelings or concerns behind it. It shows empathy and provides an opportunity for the client to express their emotions. Fear of dying alone is a common concern for many individuals facing the end of life, and addressing this fear can help alleviate distress.
C. "We will call your family in time for them to get here." While involving the family is important, this response primarily focuses on the logistics of family arrival rather than addressing the client's emotional needs. It may not fully explore or validate the client's feelings about dying alone.
D. "I will make sure a staff member is in your room at all times." While providing support and ensuring the client's comfort is essential, this response does not directly address the client's emotional needs or explore their concerns about dying alone. It also may not be feasible to have a staff member constantly present in the room. This option may not fully address the client's underlying fears or emotions related to dying alone.

A. Apply petroleum jelly to the client's lips after oral care: Applying petroleum jelly to the client's lips can help prevent dryness and cracking, particularly in immobile clients who may have difficulty maintaining moisture in their oral mucosa. This action helps promote comfort and prevent complications such as lip fissures and discomfort during oral care. Therefore, it is an appropriate action for the nurse to take.
B. Use the thumb and index finger to keep the client's mouth open: Forcing the client's mouth open with the thumb and index finger can be uncomfortable and may cause injury. Gentle techniques should be employed to maintain the client's mouth open if necessary, such as using a mouth prop or asking the client to open their mouth voluntarily.
C. Turn the client on his side before starting oral care: Turning the client on their side is an essential safety measure, particularly for immobile clients, to prevent aspiration and facilitate drainage of oral secretions during oral care. This position helps ensure that any excess fluid or debris can drain out of the mouth rather than pooling in the back of the throat, reducing the risk of aspiration pneumonia. Therefore, it is an appropriate action for the nurse to take.
D. Use a stiff toothbrush to clean the client's teeth: Using a stiff toothbrush can cause injury to the client's gums and oral tissues, especially if the client is immobile or has delicate oral tissues due to medical conditions or treatments. A soft-bristled toothbrush or sponge applicator should be used for oral care to avoid trauma and ensure thorough but gentle cleaning.